Which primary care providers offer family planning services?

Guidelines from the Centers for Disease Control and Prevention (CDC) encourage primary care providers to offer comprehensive family planning services, but many clinicians lack the training or support to do so. A study examining the characteristics of primary care providers that offer services such as contraceptive counseling is the Editor’s Choice for the November/December issue of Women’s Health Issues. The authors’ findings showed wide variation between clinicians, suggesting a need to better incorporate family planning services into primary and other outpatient care settings.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

Alex Schulte of UC Berkeley School of Public Health and M. Antonia Biggs of UCSF used data from the National Ambulatory Medical Care Survey and identified family planning service provision by outpatient providers not part of the Title X family planning network or Planned Parenthood. Among 53,489 patient visits with reproductive-age (15–49 years) individuals between 2011 and 2019, the authors found that eight percent involved family planning services: contraceptive counseling, contraceptive pill or shot, placement of an intrauterine device (IUD), placement of a hormonal implant, sterilization, or abortion. Contraceptive counseling was the family planning service provided most often, they report.

Schulte and Biggs found that family planning services were more likely to be provided in rural areas than urban areas; at community health centers compared with private physician practices; and when the patient saw a physician assistant or nurse compared with only a physician. They also found a high level of between-clinician heterogeneity, which indicates that some clinicians were much more likely than others to provide family planning services.

“Our results suggest that more work may be needed to ensure clinicians are willing and able to provide family planning care as recommended by the CDC and several professional medical societies,” write Schulte and Biggs. They note that training and support for patient-centered counseling can help providers offer high-quality contraceptive care and that system-level changes such as payment incentives and changes to scope of practice laws might also be necessary.

Schulte spoke to Contraceptive Technology Update about the study findings and commented, “In primary care visits, providers typically ask about diet. But they can also routinely ask about pregnancy intentions and offer contraceptive counseling, as needed … I think it should be standard practice.”

“The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization has resulted in abortion bans that make it harder for people in several states to control their reproductive lives,” said Karen McDonnell, Editor-in-Chief of Women’s Health Issues and associate professor of prevention and community health at Milken Institute SPH. “While working to improve access to abortion, we should also be promoting better access to contraception, and involving more primary care providers in family planning care is an essential component.”

“Association Between Facility and Clinician Characteristics and Family Planning Services Provided During U.S. Outpatient Care Visits” has been published in the November/December 2023 issue of Women’s Health Issues.